经皮腔内血管成形术与手术治疗血液透析患者自体动静脉内瘘狭窄的临床效果比较

发布时间：2018-08-17 20:07

【摘要】：目的动静脉内瘘(AVF)狭窄发生率高,选择外科手术会造成患者血管资源耗竭,而经皮腔内血管成形术(PTA)可以保留可供造瘘的血管资源,但选择PTA或外科手术尚无更明确的界定。文中通过比较PTA和内瘘切除重建手术治疗血液透析患者自体AVF狭窄的疗效,旨在寻找合适的治疗方式。方法回顾性分析2015年1月1日至2017年3月30日南京明基医院肾内科血液净化中心尿毒症维持性血液透析自体AVF狭窄的46例患者。包括行经皮腔内血管成形术者为PTA组(22例),内瘘切除重建手术者为手术组(24例)。比较2组临床一般情况,术后6个月通畅率,总体通畅时间,以及手术不良反应。结果 PTA组内瘘血管狭窄个数较手术组增多[(2.78±1.43)vs(1.67±0.71)个],差异有统计学意义(P0.05)。2组的6个月通畅率差异无统计学意义(P=0.828)。PTA组内瘘血管共狭窄57处,其中吻合口12处狭窄(21.05%),狭窄程度平均为79.3%;内瘘静脉流出道43处狭窄(75.44%),平均狭窄程度为84.26%。PTA组3例患者发生肱动脉穿刺部位血肿,未予特殊处理,自行吸收痊愈。手术组1例术中发生轻度渗血,处理后好转;术后4例有术侧手背轻度肿胀,逐渐好转;2组不良反应例数差异无统计学意义(P0.05)。结论对于3处及3处以上的多处狭窄优先选择PTA治疗,通畅率相当的同时可以更好的保留血管资源。
[Abstract]:Objective The incidence of arteriovenous fistula (AVF) stenosis is high. Surgical selection may lead to the depletion of vascular resources. Percutaneous transluminal angioplasty (PTA) can preserve the vascular resources available for fistula, but the choice of PTA or surgical operation has not been clearly defined. Methods A retrospective analysis was made of 46 patients with autologous AVF stenosis undergoing maintenance hemodialysis from January 1, 2015 to March 30, 2017 in the Blood Purification Center of Nanjing Mingji Hospital. Results Compared with the operation group, the number of stenosis of internal fistula in PTA group increased [(2.78 There were 57 stenosis of internal fistula vessels, including 12 stenosis of anastomotic stoma (21.05%) and an average of 79.3%; 43 stenosis of internal fistula venous outflow tract (75.44%) and an average of 84.26%. Three patients in PTA group developed hematoma at the puncture site of brachial artery without special treatment and recovered by self-absorption. There was no significant difference in the number of adverse reactions between the two groups (P
【作者单位】：南京医科大学附属南京明基医院肾脏内科;南京医科大学附属南京明基医院介入科;
【基金】：南京市科技发展计划项目(201715065)
【分类号】：R692.5

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